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Q: I recently received a diagnosis of gastroparesis. I am 73. I understand that an effective
treatment is available. My gastroenterologist has recommended a special diet to help me gain
weight.

A: Gastroparesis occurs when muscles inside the stomach decrease their movement, causing the
stomach to delay emptying its contents. Food stays in the stomach longer than it should.

The problem is caused by many conditions — especially those, such as multiple sclerosis and
Parkinson’s disease, that affect the nerves serving the stomach.

Diabetes is probably the most common cause, as long-standing diabetes affects all the nerves of
the body. Often, no specific cause is found.

The most common symptoms are nausea, abdominal discomfort, early satiety (a full feeling after
eating little food) and vomiting. The symptoms are also common in blockages of the stomach, so the
diagnosis frequently takes time.

If the gastroparesis is due to another condition, treating that condition might help. In a
diabetic, for example, keeping diabetes under the best control possible makes sense. You mentioned
diet: Low-fat and low-fiber diets tend to be best because fat usually slows the emptying of the
stomach and fiber is hard for the stomach to clear. Smaller, more frequent meals are better
tolerated.

Many medications, such as metoclopramide, can be helpful in treating gastroparesis. In severe
cases, cisapride is effective but unfortunately associated with serious heart-rhythm problems, and
its usage in the United States is restricted.

Q: I am a 72-year-old female. I was taking 70 milligrams of Fosamax once a week. My dentist
advised me to discontinue the Fosamax because I have several dental implants.

When I went back to my family doctor with the advice, the only option he had for me was to take
three 600-mg tablets of calcium, with 500 international units of vitamin D-3, daily. Is that my
only option for osteoporosis?

A: Your dentist is concerned about a rare condition called osteonecrosis of the jaw.
Fortunately, the risk is low — probably less than one case in every 10,000 people taking oral
medicines such as Fosamax. Injection drugs such as zoledronic acid (Reclast) are more likely to
cause the rare problem, especially when given as part of cancer treatment, in which doses tend to
be higher.

Fosamax, like Actonel and Boniva, lasts for years inside bone tissue, so going off it for a
while probably won’t hurt your bones.Calcium and vitamin D are important for all women with
osteoporosis. The other options, if necessary, include teriparatide (Forteo).

Dr. Roach answers letters only in his North America Syndicate column but provides an order form
of available health newsletters. Write him at P.O. Box 536475, Orlando, FL 32853-6475; or
ToYourGoodHealth@med.cornell.edu.